Forward Thinking

Can States Nullify Fed Law on Health? How 'bout Pot?

By J.J. Goldberg

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Gov. Rick Scott (R-Fla.)

Florida’s Tea Party-backed Gov. Rick Scott announced that he will refuse to implement the Affordable Healthcare Act, despite President Barack Obama’s reelection. Refusing to set up a state exchange doesn’t necessarily matter that much, since the law empowers the federal government to set up an exchange for states that fail to do so on their own. But more than half the expanded coverage in the law is supposed to come from a federally-subsidized expansion of Medicaid. So if Scott refuses to permit his state’s Medicaid to be expanded despite the federal subsidy (the feds cover 100% of the cost of expansion through 2016, dropping to 90% by 2020 – not a big burden on the states), then the impact of the law is crippled.

Conservative groups are urging other governors to refuse.

This raises an interesting question. State nullification of federal law was supposed to have been settled by the Civil War, but it’s suddenly become a big issue again. And not just on the right. The legalization of marijuana in a growing (get it?) number of states is setting up a serious confrontation with Washington, which still classifies weed as a Class I illegal narcotic, right alongside heroin, and is still raiding growers even in states where they’re acting legally.

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NYT: Health Law Worsens Doc Shortage...Not (Oops)

By J.J. Goldberg

Here’s an object lesson in the power of headlines to mislead: The lead headline in today’s Sunday New York Times, the paper’s most-read edition, warns: “Doctor Shortage Likely To Worsen With Health Law.” Sounds bad, right? Whatever you think of Obama and his Care, you can’t be happy if the reform results in fewer doctors providing the care we need.

Except that’s not what the story says. Once you’ve read a few paragraphs in, you realize that the problem is something quite different: We already have too few doctors doing primary care — because the current system pushes doctors into the better-paid specialties — and this shortage will be felt more intensely as the new system allows more people to seek the care they need.

The article goes on to explain the new law actually addresses the shortage, but not fast enough—it takes 10 years to train new doctors, and besides the fix in the new law isn’t strong enough. That is, the new law doesn’t create a doctor shortage — it fixes it, but not fast enough, and in the meantime the flaws in our current system will become more apparent. And, like the Bush economic disaster, it will appear to be Obama’s fault.

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